Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (1)

Reflections On Nursing Education

The discussion regarding the entry level for nursing has been ongoing for decades. I have articles written in the 1940s extolling the virtues of the BSN long before the first ADN program opened in 1952.

Every now and then, someone broaches the topic of making the BSN the entry level and BAM! the flames that ensue make the health care reform debate look like Mr. Roger’s Neighborhood.

Why the rancor?

Well, if one states that the BSN should be the entry level for a registered nurse, then it follows there must be a reason why an ADN should not.

That does not sit well with ADN graduates.

It sure didn’t sit well with me.


Now, 5 months away from graduating with my BSN, I see a difference.

Or, I guess you can say I feel a difference.

I am a different nurse than I was 2 1/2 years ago.

Notice, I didn’t say “better”.


My clinical skills are the same.

If you want to define nursing as the ability to put the right tube in the right orifice using the right technique, the BSN gives no advantage. Clinical skills for the ADN and the BSN are taught in class but honed in practice. While the ADN program may include more clinical hours, it has been my experience that neither program produces nurses ready to “hit the road running”.

My understanding of nursing has broadened.

Some disdain nursing theory and say it has no basis in daily practice, but have they really looked at what theories are out there? All nursing programs are based on one. For me it was Sister Calista Roy’s Adaptation Model. Theories give a framework, a way of approaching assessment and care, a nursing philosophy.  You can argue that it’s useless, but you are using one every day, whether you realize it or not.  Now, it will be a cold day in Hades before I use “Energy Field Disturbance” as a nursing diagnosis but until I studied theory, I had no idea that Rogers’  Science of Unitary Human Beings even existed.  When I saw Jean Watson’s Theory of Human Caring, it was like getting hit by lightening. Watson’s theory, to me, is nursing.

Do my patients know which nursing theory I adopt? No. Do they care? No.

But I know. And I care. My nursing care has more depth, more perspective and a greater meaning to me because of the wider knowledge obtained through an in depth study of nursing theory.

I didn’t get that in my ADN program.

The nursing profession is more diverse than I imagined.

Okay, yeah I knew there was home health and public health was something done “out there” somewhere and some nurses worked 9-5 in a clinic, but like a horse wearing blinders, all I saw is what was right before me. Bedside hospital nursing.  That’s what I was educated to do.  Anything outside of bedside nursing required a BSN, minimum. No way was I going to do that! Blech! I lived nursing full time as it was.

As a result, I was never able to take advantage of opportunities that were there when I was so burnt out at the bedside I left crumbs when I walked.

Case management, nurse practitioner, becoming a nursing professor, home health, nursing research, school nursing and lord almighty, public health!!!!  I had no idea about public health – I thought it was visiting people in homes and running immunization clinics. It is that, but it is so much more!

You can advocate for patients, thousands at a time, in so many ways!

I was not exposed to that in my ADN program.


I guess you could say the last 2 1/2 years have been a transforming process for me. The BSN program has enriched my life, my practice and, although they would never know it, my patients.

So, do I think the BSN should be the entry level degree into nursing?

Well, if I said yes, I’d need Secret Service protection!

I would say if you are just entering the profession and it’s at all feasible for you, go the BSN route from the start.

I think it should be required – BUT (hold your fire!) there’s much to be said for being an ADN grad and then going for the BSN. In fact, I would almost recommend that. I know that I have gotten so much more out of the BSN education with many, many years of clinical practice behind it.

When you are an ADN and you are studying for the BSN, you have perspective, a place to assimilate what you are learning into your current practice. Subjects like nursing theory and research take on a clearer perspective, as opposed to being vague ideas and dull methodologies.

The BSN is worth getting.  I know I have developed both personally and professionally.

(Now, if I can just get through this last semester…)

*This blog post was originally published at Emergiblog*

You may also like these posts

    None Found

Read comments »

One Response to “Reflections On Nursing Education”

  1. Heather Hurley says:

    I agree with you wholeheartedly with a “but”….I am about to retire in two weeks, and I can tell you that from my perspective, being a diploma grad, then going back and getting my BSN (they accepted none of my previous training but I got to CLEP some courses)…BSN nurses have a better handle on how to create individual care plans for individual patients with individual needs…However! What wasn’t addressed in your blog was the fact that, in the real world, despite the state of today’s economy, we face a serious nursing shortage, and the impetus is to get as many educated in as short a time possible. This does not bode well for patients in the long run, of course,
    but unfortunately for most hospitals, economics wins out. As more of us baby boomers begin retiring (I’m at the beginning year), the shortage will reach huge proportions, I’m guessing. Good luck in your endeavors. My BSN afforded me many opportunities in nursing (such as teaching fetal monitoring workshops, for example) that I would not have had otherwise.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »